The following is a discussion of Halachic topics related to the Parsha of the week.For final rulings, consult your Rav.

MEDICATIONS ON SHABBOS

One of several Rabbinical decrees that our Sages enacted in order to guard
the sanctity of Shabbos concerns the use of medications. In the opinion and
experience of the Rabbis, easy access to medicine may lead to the
transgression of certain Shabbos Labors. While issuing the decree, however,
the Rabbis were bound by the halachic principle of being as lenient as
possible with those suffering pain or distress. Thus, they established
guidelines for determining when it is permitted to take medication on
Shabbos and when it is not. Towards the end of this discussion, we will
list many common conditions which normally require medication and how they
are dealt with on Shabbos.

EXPLANATION OF THE RABBINICAL PROHIBITION

To determine when one is allowed to take medicine on Shabbos for non
life-threatening conditions, we must focus on two separate halachic
considerations. First of all, we must ascertain that none of the thirty-nine
Shabbos Labors is being transgressed in any way, either Biblical or
Rabbinical. Obviously, we cannot prepare medication by either grinding raw
material or mixing it; we cannot buy medication at a drug store; we cannot
put on a light to see where medication was stored, and so on. In this
regard - in determining that there is no transgression of the thirty-nine
forbidden Shabbos Labors - there is no difference between this Shabbos
prohibition and any other.

However, the prohibition against using medication on Shabbos is also
governed by a Rabbinical decree against using medication on Shabbos even
when no forbidden Shabbos Labor is performed. The Rabbis prohibited
unrestricted use of medication on Shabbos for fear that it would lead to the
violation of one of the thirty-nine Shabbos Labors. The Labor which
concerned the Rabbis most was "grinding", since grinding some substance is a
prerequisite for almost every medicinal preparation(1).

Once the Rabbis prohibited using medicine on Shabbos, they included in this
prohibition any kind of treatment or procedure which could involve the use
of medicine - even if medicine is not actually being used. The classic
example in the Shulchan Aruch is the prohibition against the old-time remedy
of sweating for medicinal purposes(2). Sweating can be induced in one of two
ways: a) by taking certain medicines which are prepared by grinding, and b)
by performing certain types of exercises. Even though exercise is totally
unrelated to taking medicine and cannot possibly lead to "grinding", it is
still forbidden to exercise on Shabbos(3) since one could also induce
sweating by the first method - taking certain medicines which are prepared
by grinding(4).

If, however, the goal of the treatment or procedure can only be achieved
without the use of medicine, then it is permitted to avail oneself of that
treatment or procedure. For example, it is permitted to press on a bump with
a knife, since the goal, which is to reduce swelling, cannot be arrived at
by taking medicine. Similarly, braces may be worn on Shabbos because there
is no medicine for aligning teeth properly.

Included in the Rabbinical prohibition are only actions which heal a wound
or alleviate pain. If the action merely serves to protect a wound from
infection(5) or to shield a healed wound from being re-injured(6), it is
allowed. It is permitted, therefore, to clean and bandage a wound or to pour
hydrogen peroxide over it.

The Rabbinical prohibition includes medications only. Food and drink,
however, are permitted even when they are being consumed for medicinal
purposes. It is permitted, therefore, to drink tea for a sore throat, to eat
almonds to relieve heartburn and to chew vitamins which serve as a food
supplement(7).

QUESTION: Nowadays, when medicine is always prepared at a pharmacy, there is
no longer any fear that using medicine will lead to "grinding". Why, then,
is this Rabbinical prohibition still in effect?

DISCUSSION: Although a minority of contemporary poskim are inclined to be
lenient with medication on Shabbos nowadays because of the change in
technique(8), the general consensus is to reject this argument. Some of the
reasons offered are as follows:

Generally, a Rabbinical decree, once enacted, is not repealed even when the
reason behind it no longer applies(9).
There are several homeopathic remedies, such as natural herbs and spices,
which are still prepared at home and require grinding. In fact, these types
of medications are gaining popularity.
In underdeveloped countries, people have never stopped preparing medicines
in their own homes.
Some modern-day medication may lead to other Biblical Labors, such as
"smoothing" or "kneading".
In spite of the above, there are some poskim who feel that nowadays we can
be somewhat more lenient when interpreting the Rabbinical decree. Although
all the poskim agree that we may not do away with the Rabbinical decree
altogether, we may, nevertheless, find some room for leniency in case of
severe distress or pain (even if the pain is localized and does not require
bed rest)(10).

QUESTION: Why did the Rabbis suspend the prohibition against taking medicine
when one feels weak all over or bad enough to go to bed?

DISCUSSION: The Talmud rules that the Rabbis suspended many of their decrees
for a person who can be classified as "ill", even if not dangerously so.
Thus, for example, it is permitted to instruct a non-Jew to do anything
which a patient may require on Shabbos, since instructing a non-Jew is a
Rabbinical prohibition. Since taking medication on Shabbos is a Rabbinical
prohibition, it is suspended when the patient can be classified as "ill".
The poskim agree that when one has fever, feels weak all over or feels bad
enough to require bed rest, he can be classified as a "patient not
dangerously ill" and medications are permitted to be taken(11).

Since "requiring bed rest" and "weak all over" are subjective terms, it is
up to each individual to determine his personal pain threshold.
Consequently, one who feels that he must lie in bed for his condition, may
take medication on Shabbos even though other people in the "same" condition
would not go to bed. As stated earlier, there is no requirement to be overly
stringent when judging the degree of illness(12).

In addition, healthy infants and babies till the age of three(13) (and
according to some poksim even older children till the age of six(14) or
nine(15)) are also halachically classified as "patients not dangerously
ill", which means that the Rabbinical prohibition against taking medication
is suspended. They are permitted to take all forms of medicine(16), provided
that no Biblical prohibitions are transgressed.

LIST OF AILMENTS AND CONDITIONS

Note: Our discussion is limited to adults who are in non-life threatening
situations. When in doubt whether or not a situation is life-threatening,
consult a rav and/or a doctor.

abscess - may be squeezed to relieve pressure from pus, even if some blood
is secreted in the process(17).

allergies (mild) - medication may not be taken.

angina - all medications are permitted.

asthma - all oral and/or breathing medications may be taken(18).

athlete's foot - all medications are prohibited.

back or neck brace - may be put on or removed(19).

bedridden(20) due to pain - all oral medications may be taken.

bee sting - the stinger may be removed and the area may be washed with ice
water, lemon juice or vinegar, etc. The area may not be soaked, however, in
those liquids(21).

bleeding (slow) - pressure may be applied to a cut to stop bleeding. Sucking
or squeezing out blood is prohibited(22).

broken bone - a non-Jew may be asked to do anything necessary, e.g., make a
phone call, drive a car, take x-rays or put on a cast. [If a non-Jew is not
available, some poskim permit a Jew to do these actions if they are done
with a shinui, in an abnormal manner(23).]

cold (running nose) - medication may not be taken.

cough - medication may not be taken. If the cough may be an indication of
pneumonia or asthma, medication is permitted.

cuts and abrasions (minor wounds) - may be washed or soaked in water.
Hydrogen peroxide may be poured over a cut. It is not permitted, however, to
soak absorbent cotton or paper in such a solution and then wash the wound
with it. The wound may be covered with a non-medicated band-aid(24).

diabetes - all oral medications may be taken.

dried (or cracked) lips - it is prohibited to apply chapstick or any other
medication, liquid or otherwise.

dried (or chapped) hands - It is prohibited to rub them with either oil,
ointment (Vaseline) or lotion. One who regularly uses a pourable, liquid
lotion or oil on his hands (whether they are chapped or not) may do so on
Shabbos, too, even if his hands are chapped(25).

ear infection - all medications are permitted. Cotton balls may be
inserted(26). Even if the infection is no longer present, the prescription
begun during the week must be continued until finished in order to avoid a
relapse.

eye inflammation - eye drops (or ointment) may be instilled in the eye. If
the eye is not inflamed but merely irritated, no medication is
permitted(27).

fever - all oral medications may be taken. A conventional thermometer may be
used(28). If a person is suffering from high-grade fever, a non-Jew may be
asked to do whatever the patient needs in order to feel better(29). If the
cause of the fever is unknown, a doctor should be consulted.

headache - medication may not be taken. If the headache is severe enough so
that one feels weak all over or is forced to go to bed, medication may be
taken. One who is unsure if he has reached that stage of illness may be
lenient and take pain relieving medication(30).

heartburn - Foods which will have a soothing effect may be eaten. Some
poskim permit taking anti-acid medication while others are more hesitant. In
a severe case, one may be lenient(31).

insect repellent - liquid or spray repellents may be used(32).

migraine headache - all oral medications may be taken.

nosebleed - the bleeding may be stopped with a tissue or a napkin. If none
is available, a cloth napkin may be used(33).

retainer - may be inserted and removed(34).

rheumatism - It is prohibited to bathe in therapeutic hot springs(35).

scab - it is permitted to remove a scab as long as blood is not drawn from
the wound(36).

sore throat - medication may not be taken. Gargling is prohibited(37).
Drinking tea or any other hot drink, or sucking a candy, is permitted even
if the intention is for medicinal purposes(38). See also 'strep throat'.

sleep disorder - There are conflicting views among contemporary poskim
whether it is permitted to take sleeping pills or no-doze pills(39). One who
is weak all over or is bedridden may take these pills. Cotton balls may be
used as ear plugs. It is questionable if it is permitted to use pliable ear
plugs, which are made from a wax-like material that must be spread to fill
the cavity of the ear(40).

sprains - If the patient is not experiencing severe pain, nothing may be
done. If the patient is experiencing severe pain, medication may be taken
and a massage may be given. A makeshift splint may be applied, provided that
no Shabbos Labors are transgressed.

splinter under the skin(41) - may be extracted with the fingers, or with
tweezers or a needle. If, unavoidably, a little blood is secreted in the
process, it is of no consequence(42).

stitches - a non-Jew is allowed to stitch any wound(43), even if the
stitching is done only for cosmetic reasons(44).

stomach cramps - Unless one is in severe pain or weak all over, it is
prohibited to take a laxative or castor oil. Prune juice or any other food
or drink is permitted. A hot water bottle is permitted when one experiences
strong pains(45).

strep throat - all oral medications may be taken. Even if the infection is
no longer present, the prescription begun during the week must be continued
until finished in order to avoid a relapse.

sunburn (ordinary) - medications are not permitted.

sweating - it is permitted to sprinkle baby powder on those parts of the
body which are perspiring(46).

swelling - It is permitted to press a knife, etc. against the skin to
prevent or minimize swelling(47). It is permitted to wash or soak the
swollen area in water(48). It is permitted to place a compress49, ice
(placed in plastic bag) or any frozen item over a swollen area(50).

toothache - a slight toothache may not be treated with painkillers, but one
is permitted to drink whiskey, etc., provided that it is swallowed
immediately(51). A severe toothache (to the point where one feels weak all
over) or gum infection may be treated with oral medication. If the tooth
needs to be extracted, a non-Jew may be asked to do so(52).

weak all over - all oral medications are permitted to be taken.

General Notes:

It is commonly accepted among the majority of poskim that the Rabbinical
restriction against taking medications on Shabbos applies to Yom Tov as
well(53). The poskim agree, however, that on the second day of Yom Tov(54)
and on Chol ha-Moed(55) it is permitted to swallow any medication, even for
the most minor of ailments. No shinui is required.

On Shabbos, a pill may be split in half(56) (even on a dotted line(57))
ground into small pieces(58) or dissolved in a cup of liquid(59).

Sometimes (as described above) a medication may not be taken on Shabbos, but
not taking it could lead to aggravating a condition to the point where the
medication would become necessary and permitted. In such a case, one is
allowed to take the medication in order to avoid this eventuality. For
example, one who has a headache which, if untreated, tends to escalate to a
migraine, may take medication before the migraine sets in(60).

One who suffers from two conditions - one for which he may take medication
on Shabbos and another for which he may not - may take medication only for
the former(61).

When ointment is permitted to be applied on Shabbos, it is forbidden to
first smear the ointment on a gauze square. Rather, before Shabbos a gauze
square with ointment on it should be prepared and then placed on the skin on
Shabbos(62). If this was not done, the ointment may be squeezed directly
from the tube on to the wound and a bandage placed over it. Whatever shinui
can be made should be employed, so as to serve as a reminder not to
inadvertently spread ointment on the skin ("smoothing"), which is
prohibited(63). [If this is impractical, there is a minority view that
permits smearing ointment directly on the body provided that all of the
ointment is absorbed into the skin and nothing remains on the surface. One
should only rely on this leniency under extenuating circumstances.]

FOOTNOTES:

1 Mishnah Berurah 327:1.

2 O.C. 328:42.

3 When the purpose of the exercise it to work up a sweat, see Beiur
Halachah, ibid. If the purpose of the exercise is to work up an appetite, it
is questionable; see Sha'ar ha-Tziyun 301:9. If the purpose of the exercise
is to lose weight, it is prohibited, since weight loss can be (partly)
accomplished by taking pills. If the exercise is for pure enjoyment, it may
be permitted according to the basic halachah. A rav should be consulted.

7 Note, however, that the purpose of many vitamins is not to serve as a food
supplement but rather to strengthen a weak body or to relieve certain
symptoms. In the opinion of many poskim, those vitamins may not be taken on
Shabbos, see Igros Moshe O.C. 3:54 and Shemiras Shabbos K'hilchasah 34, note
85, quoting Harav S.Z. Auerbach. See, however, Titz Eliezer 14:50 who takes
a more lenient approach concerning vitamins on Shabbos.

8 The complex preparation entailed in manufacturing modern medicine is
another reason for leniency, since it may be argued that the Rabbis were
fearful that "simple" and quick Labors such as grinding would be
transgressed; they did not fear that someone would engage in the lengthy and
involved processing required today.

9 See Igros Moshe O.C. 2:100 for a general explanation of this rule.

10 See Minchas Shabbos 91:9; Ketzos ha-Shulchan 134:7; Chelkas Yaakov 4:41;
and Tzitz Eliezer 8:15-15. See also Minchas Yitzchak 3:35 who permits taking
aspirin for a headache when one is in severe distress.

11 Entire paragraph based on O.C. 328:17 and 37 and Mishnah Berurah, ibid.
[Note that although Shulchan Aruch rules that a shinui is required for
Rabbinical prohibitions to be suspended, the general consensus of the poskim
is that this restriction is waived when taking oral medication. When using
other medications, however (such as ointment) it is proper to employ a
shinui, see Mishnah Berurah 328:85 and 130.]

15 Minchas Yitzchak 1:78. In the final analysis, it all depends on the
strength and maturity of the child.

16 Rama O.C. 328:17. Note, however, that not all of a baby's needs are
exempted from the prohibition against medication, see, for instance, Mishnah
Berurah 328:131 and 330:36. See Tehilah l'David 328:24 who deals with this
difficulty.

17 O.C. 328:28 and Mishnah Berurah 89.

18 See The Journal of Halacha and Contemporary Society # 6, pg. 47 for a
full discussion of how to treat asthma on Shabbos.

20 Even if he is capable of getting out of bed and walking around, but
presently he is in bed due to his pain, he is considered as bedridden; Aruch
ha-Shulchan 328:19.

21 See Mishnah Berurah 328:141,142. Obviously, one who is allergic to a bee
sting must do everything necessary to avert danger.

22 Mishnah Berurah 328:147.

23 This is the view of Shulchan Aruch Harav 328:19 and Eglei Tal (Tochen
18). Some poskim (Harav S.Z. Auerbach, quoted in Shemiras Shabbos
K'hilchasah 33, note *17) rule that one may rely on this view, especially
when there is "danger to a limb". Note, however, that Mishnah Berurah and
Aruch ha-Shulchan and the majority of the poskim do not agree with this
leniency.

24 Some poskim (oral ruling by Harav M. Feinstein; Harav S.Z. Auerbach in
Tikunim u'Miluim, pg. 58; Harav C.P. Scheinberg, quoted in Children in
Halachah, pg. 88; Az Nidberu 7:34,35) permit removing the protective tabs
from a band-aid, while other poksim (Minchas Yitzchak 5:39-2; Harav Y.S.
Elyashiv, quoted in Machazeh Eliyahu 70) are stringent. It is proper to
prepare band-aids for Shabbos use by peeling off their protective tabs and
re-sealing them before Shabbos. Once they have been prepared in this
fashion, they may be used on Shabbos (Tzitz Eliezer 16:6-5).

41 If the thorn or splinter is under a fingernail, it may be considered
dangerous.

42 Mishnah Berurah 328:88 and Sha'ar ha-Tziyun 63.

43 See Nishmas Avrohom, vol. 4, O.C. 340 who quotes Harav S.Z. Auerbach and
Harav S. Y. Elyashiv as ruling that stitching a wound may be a Biblically
prohibited activity. Accordingly, only a non-Jew may do it, unless it is a
life threatening situation.

51 O.C. 328:32. It may not be retained in the mouth longer than usual, nor
may one rinse his mouth with it and then spit it out.

52 Rama O.C. 328:3. See Tzitz Eliezer 9:17 (2-11).

53 Mishnah Berurah 532:5. There is a minority opinion that permits taking
medications on Yom Tov, see Tzitz Eliezer 8:15 (16) who quotes this opinion
and rules that when in distress one may rely on this view.